The diagnosis of primary liver cancer related to chronic viral hepatitis infection in Australia is on the rise.
Primary liver cancer is one of the fastest increasing causes of cancer death and has the second fastest increasing incidence of all cancers. Liver cancer survival remains low, with less than 17% of people still alive 5 years after diagnosis. 1
Aboriginal and Torres Strait Islanders are more likely to develop liver cancer than non-Indigenous Australians and are 2.5 times more likely to die from liver cancer. 2
Globally, viral hepatitis is responsible for 80% of liver cancers. The majority of primary liver cancers are from untreated chronic hepatitis B or C infection.
- There are 226,566 people living in Australia with chronic hepatitis B infection.3
- Most of these infections are in people from countries with a high prevalence of hepatitis B and were infected at birth or in childhood, and Aboriginal and Torres Strait Islander people.
- Without medical intervention, 1 in 4 people living with chronic hepatitis B infection will die from liver cirrhosis or liver cancer.
- 31.9% of people are unaware they have chronic hepatitis B and may be symptomless.3
- Only 22.1% of people diagnosed with hepatitis B were engaged in care (either treatment or monitoring) in 2018.3
- Appropriate treatment for chronic hepatitis B can reduce the risk of liver cancer by up to 75%.
- Hepatitis B infection is vaccine preventable and many people are eligible for free vaccinations.
- There are 188,951 people in Australia living with chronic hepatitis C infection.3
- Most new infections are related to the sharing of injecting drug equipment.
- 60–70% of those with chronic infection will develop chronic liver disease, 20–30% will develop cirrhosis, and 1–5% will be diagnosed with liver cancer.
- There is no vaccine for hepatitis C, but treatment is available.
- There are new drugs available which can cure the hepatitis C virus in 95–97% of cases in as little as 8 weeks, and have few or no side effects.
- Between March 2016 and June 2019, hepatitis C treatment uptake was 39.5% across Australia.
- Testing is recommended for:
- people who inject drugs or who have ever injected drugs
- people in custodial settings
- men who have sex with men
- people with evidence of liver disease (e.g. raised transaminases)
- people who have migrated from high prevalence regions should be tested at least once (regions include Africa, Eastern Europe, Egypt, Mediterranean, Pakistan, Southern Asia)
- Aboriginal and Torres Strait Islander people
- people who received a blood transfusion before 1990.4
Early diagnosis is the key for liver cancer prevention
- Liver cancer (hepatocellular carcinoma) is rarely detected early and is the fastest increasing cancer in Australia, with a nearly 4-fold age-standardised increase from 1.8 to 8.6 per 100,000 persons between 1982 and 2019.
- In Victoria 2018, there were 458 new cases of liver cancer in men and 132 new cases in women.
- The five-year survival for people with liver cancer is poor (23%) so early detection is important.
- Chronic hepatitis C and B infections and alcohol are the leading cause of liver cancers, with non-alcoholic fatty liver disease (NAFLD) related liver cancer increasing rapidly. The risk factors for NAFLD are obesity, type 2 diabetes and metabolic syndrome.
- Surveillance is recommended for liver cancer in patients with cirrhosis or specific groups with chronic hepatitis B. This includes six-monthly abdominal ultrasound tests which are often combined with alpha-fetoprotein (AFP) in patients in the following high-risk groups:
|Chronic hepatitis B
||Chronic hepatitis C
- All patients with cirrhosis
- Patients with a family history of liver cancer
- Males from Asia ≥ 40 years
- Females from Asia ≥ 50 years
- Africans ≥ 20 years
- All patients with cirrhosis (including those who are cured by HCV therapy)
|Patients detected through surveillance have significantly improved outcomes.
Health professional resources
Research and policies
Cancer Council Victoria's Screening, Early Detection and Immunisation Program works to address the rise of liver cancer caused by viral hepatitis. The program has a focus on reducing the percentage of people with hepatitis who are undiagnosed as well as increasing access to medical monitoring and treatment.
For more information on the program contact the Viral Hepatitis Program Co-ordinator Charissa Feng.